Who's Afraid of Susan Sontag?

20 Pages·2005·2.04 MB·English

© 2001 The Society for the Social History of Medicine
Who's Afraid of Susan Sontag? or, the Myths and
Metaphors of Cancer Reconsidered
By BARBARA CLOW*
SUMMARY: Susan Sontag's book, Illness as Metaphor, has framed our understanding of the
relationship between disease metaphors and illness experiences in modern Western society. D
Her view that metaphors can render diseases socially as well as physically mortifying has ow
influenced a generation of scholars: her conclusion that cancer sufferers are shamed and nlo
silenced by metaphors has likewise shaped public perception of neoplastic diseases. Despite ad
e
the eloquence of Sontag's prose and the force of her convictions, her conclusions are not d
wholly persuasive. Some scholars have critiqued her faith in the power of science to dispel fro
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the myths and metaphors of disease; others have pointed out that it is neither desirable nor h
possible to strip illness of its symbolic meanings. It has been my purpose to test Sontag's ttp
assumptions about the impact of cancer metaphors, to weigh her arguments against the ://s
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experiences and attitudes embodied in patient correspondence, obituaries and death m
notices, medical and educational literature, and fiction. Popular and professional reactions .o
x
to neoplastic diseases in both Canada and the United States during the first half of the fo
rd
twentieth century reveal that, while many North Americans regarded cancer as a dreadful jo
affliction, the disease did not, as Sontag has argued, predictably reduce them to a state of urn
silence or disgrace. als
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KEYWORDS: cancer, culture, metaphor, Sontag, illness experience, North America arg/
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'A lot of people are afraid of Susan Sontag,' declared journalist Helen Benedict l C
after an interview with the celebrated author.1 Sontag's formidable intelligence, he
n
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her polished public persona, and the inordinate protectiveness of her publicists K
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combine to make the author seem remote and forbidding. 'Getting to meet her', n
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Benedict reported, 'is a bit like trying to meet Joan of Arc on her day off'. Sontag's U
n
reputation as a 'heavy-weight intellectual' is well deserved, not least of all for her ive
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analysis of disease discourse. Her remarkable essay Illness as Metaphor, published in ity
1977, struck a chord that resonated with the public as well as with academics.2 On L
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the one hand, patients drew comfort from her attempt to make sense of the cancer ra
ry
experience. Ten years after publication of the book, Sontag claimed that 'Hun- o
n
dreds of people have written to me and have said that it saved their lives, that M
a
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because of the book they went to a doctor or changed their doctors.' On the other 2
1
hand, her work excited considerable interest among scholars, contributing a new , 2
0
1
3
* Department of History, Dalhousie University, Halifax, Nova Scotia, Canada B3H 3J5. E-mail:
[email protected]
1 H. Benedict, 'Passionate Mind: Susan Sontag', in Portraits in Print: A Collection of Profiles and the
Stories Behind Them (New York, 1991), p. 21.
2 A decade after publishing Illness as Metaphor, Sontag wrote a second analysis of the symbolic
meanings of disease entitled AIDS and Its Metaphors. Because I am using the introduction to the second
book, which contains Sontag's reflections on the first book, as well as her original discussion of illness
metaphors, I have elected to use an edition published by Anchor Books that includes both texts. See
S. Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York, 1990). In order to avoid con-
fusion, I will refer to this source only as Illness as Metaphor in subsequent footnotes.
0951-631X Social History of Medicine Vol. 14 No. 2 pp. 293-312
294 Barbara Clow
conceptual framework to the burgeoning movement to study patient experiences,
illness narratives, and health culture, to name only a few areas of research.3
Undoubtedly, Sontag's interpretation has much to recommend it. Her book
would not have enjoyed such immediate success or enduring influence had it not
presented a compelling or provocative analysis of illness. Historian Sheila Roth-
man, for example, explicitly identified her exploration of the experiences of tuber-
culosis patients with Sontag's efforts to de-mystify disease. Moreover, Illness as
Metaphor not only powerfully alerted us to the existence and importance of disease D
o
metaphors, but also moulded our understanding of their impact on illness experi- w
n
ence. In his history of cancer in American culture, James Patterson developed and lo
a
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reinforced Sontag's central argument that cancer patients have long suffered in e
d
silence as a result of the stigma attached to neoplastic diseases.4 fro
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Despite the potency of Sontag's vision, however, it does not necessarily follow h
tfhreaetl yh ear dcmonitcteluds itohnast asbhoeu ht atdh ed iomnpea cnto osfy dsitseemasaeti mc eretaspeahrocrhs aforer atlhwea ybso orekl,i adbrlea.w Sinhge ttp://sh
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instead on her expansive knowledge of literature and her private library for pithy .o
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quotations and pertinent examples. Moreover, while she elaborated a convincing fo
rd
portrait of disease as symbol, her assertion that metaphors warp illness experience is jo
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less persuasive, substantiated mainly by her personal confrontation with cancer and rn
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her limited exposure to other victims of the disease. Sontag's assumptions conse- .o
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quently must be weighed against the experiences of sufferers in the past as well as a/
against the broader discourse on cancer. The following exploration of popular and t N
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professional reactions to neoplastic diseases in Canada and the United States during tio
n
the first half of the twentieth century shows that, although many North Americans al C
regarded cancer as a dreadful affliction, the disease did not necessarily reduce them h
e
n
to a state of silence or disgrace.5 g
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This article is divided into four sections. The first briefly describes Sontag's un
g
own illness experience and outlines the main tenets of her argument about cancer U
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metaphors as presented in Illness as Metaphor. The second section draws on a wideiv
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variety of sources, including obituaries, health-education and medical literature, rsity
and patient correspondence, to evaluate Sontag's interpretation of neoplastic L
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diseases. More specifically, this part of the discussion challenges her assertion that ra
ry
silence and shame invariably characterize the cancer experience. The third part o
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of the paper is devoted to a reconsideration of the relationship between disease M
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metaphors and illness experiences. By comparing the experiences of cardiovascular y 2
1
, 2
Sontag quoted in M. Costa and A. Lopez, 'Susan Sontag: The Passion for Words', reprinted in L. 01
3
Poague (ed.), Conversations with Susan Sontag (Jackson, MS, 1995), p. 230; D. Lupton, Medicine as
Culture: Illness, Disease and the Body in Western Society (London, 1994); C. G. Helman, Culture, Health
and Illness: An Introduction for Health Professionals, 3rd edition, (Oxford, 1994); A. H. Hawkins, Recon-
structing Illness: Studies in Pathography (West Lafayette, IN, 1993); A. M. Brandt, 'Emerging Themes in
the History of Medicine', The Milbank Quarterly, 69 (1991), 199-213; R. J. Evans, Death in Hamburg:
Society and Politics in the Cholera Years, 1830-1910 (London, 1987); H. Brody, Stories of Sickness (New
Haven, CN, 1987).
4 S. M. Rothman, Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in
America (New York, 1994); J. Patterson, The Dread Disease: Cancer and Modem American Culture (Cam-
bridge, MA, 1987).
3 W. Lesser, 'Interview with Susan Sontag', in Poague, Conversations, p.195.
Who's Afraid of Susan Sontag? 295
and neoplastic diseases, a comparison prominent in Sontag's own work, I argue
that metaphors are as much a product of the lived experience of disease as they
are a transforming influence on that experience. Finally, the essay examines the
representation of cancer in Thomas Wolfe's novel, Of Time and the River. One of a
mere handful of fictional accounts of cancer published in the years before the
Second World War, the book would seem to support Sontag's view that neoplastic
diseases were both shameful and unmentionable. Yet close scrutiny of Wolfe's
handling of the subject serves as a cautionary tale, underscoring the complexity of
D
personal and popular reactions to cancer, and the limitations of Sontag's inter- ow
n
pretation. lo
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Sontag and Cancer m
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In 1975, Susan Sontag was in her intellectual prime, an author of prodigious talent. ttp
A regular contributor to such prestigious journals as Harper's, Atlantic Monthly, the ://sh
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New Yorker, and the New York Review of Books, she had also written no fewer than .o
x
five books and directed three feature-length films. In both media, Sontag grappled fo
rd
fearlessly with such controversial issues as pornography and the Vietnam war, jo
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carving out a niche for herself in the American literary establishment: she 'became rn
a
known both as an astute, sophisticated commentator on modernism and the avante- ls.o
garde and as an experimental novelist'. Moreover, Sontag's rise to prominence was arg/
nothing short of meteoric, leaving fans and critics alike astonished at the extent of t N
her popularity.6 atio
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Then, at the age of 42, Susan Sontag learned that she had breast cancer. 'I had al C
never been seriously ill', she recalled a few years later. 'Suddenly, I entered the h
e
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world of the sick.' From the start, doctors warned Sontag that her condition was g
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very grave because the disease was already well established and appeared to be u
n
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spreading rapidly. Indeed, her chances of survival seemed slim, perhaps no better U
n
than 10 per cent. Sontag's physicians recommended immediate and aggressive inter- iv
e
vention; a radical mastectomy followed by intensive chemotherapy, they argued, rsity
offered the best, perhaps the only, hope of beating the disease. But, consistent with L
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her irreverence for authority and convention, Sontag did not immediately accept ra
this advice. Instead, she sought other medical opinions, consulting surgeons in ry o
n
Cleveland and doctors in France who were experimenting with less drastic tech- M
a
niques for the treatment of breast cancer. Eventually, however, Sontag consented y
2
to a radical mastectomy, acknowledging the need for extreme measures. 'So little 1, 2
was known', she later remarked, 'that if there was only a tiny advantage to the 01
3
radical, I would do it. I certainly didn't want any additional mutilation, but I
wanted to live.' Over the next two and a half years, Sontag underwent four subse-
quent operations to deal with secondary lesions, as well as 30 months of intensive
chemotherapy.7
6 'Susan Sontag', in E. Showaker, L. Baechler, and A. W. Litz (eds.), Modern American Woman
Writers (New York, 1991), pp. 471-2; Benedict, 'Passionate Mind', pp. 22-3.
7 Sontag quoted in Costa and Lopez, 'Passion for Words', p. 229; Sontag quoted in C. Kahn, 'Alone
Against Illness', Family Health, 10 (November 1978), 50-3.
296 Barbara Clow
She was lucky. Against seemingly desperate odds, Sontag survived her con-
frontation with cancer. Yet the experience left her profoundly shaken. For months
after her initial diagnosis, she was unable to write anything; then she worked
frantically, feverishly - uncertain, as she later wrote, 'about how much time I had
left to do any living or writing in'. Moreover, as she sat in hospital wards and
waiting rooms alongside others victims of the disease, Sontag was struck by the
extent to which cancer was not merely a physical affliction, but also a formidable
social handicap. 'I discovered that many patients . . . are embarrassed about being
D
sick', she observed. 'The doctors also treated the cancer as if it were something ow
n
more than an illness: It wasn't like having a heart attack . . . there was a taboo about lo
a
it;8 de
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Sontag's experience with cancer and her observations of other sufferers event- fro
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ually led her to take up her pen, not only to share the details of her personal h
travail—as some of her contemporaries were beginning to do—but also to expose ttp
the pernicious influence of disease metaphors. Drawing on classic and contem- ://sh
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porary texts in both literature and medicine, she argued that two diseases in the .o
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modern era have been 'spectacularly, and similarly, encumbered with the trappings fo
rd
of metaphor': tuberculosis in the nineteenth century, cancer in the twentieth. jo
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Admittedly, the metaphors associated with each disease were rather different. rn
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Tuberculosis enjoyed at least some measure of lustre along with connotations of ls.o
taint, while cancer was regarded with unmitigated horror, an illness experience arg/
with no redeeming virtue. Despite the differences in the symbolic meanings t N
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attached to these diseases, Sontag claimed that both served as 'master illnesses' in tio
n
the modern era, signifying the depths of moral, social, or political depravity. She a
l C
observed, for example, that D. H. Lawrence described masturbation as 'the deepest h
e
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and most dangerous cancer of our civilization' while the Nazis sought to justify g
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genocide by likening the Jews to a cancerous lesion that sullied the 'pure' body of u
n
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the German people. In this way, cancer became synonymous with malevolence as U
well as malignance.9 niv
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According to Sontag, these kinds of symbolic associations deformed the illness rsity
experiences of cancer patients in a number of important ways. Metaphors height- L
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ened the social and psychological anguish occasioned by a diagnosis of cancer ra
ry
o
8 Sontag, Illness as Metaphor, p. 101; Sontag quoted in Costa and Lopez, 'Passion for Words', p. 151. n M
See alsoJ.-L. Servan-Schreiber, 'An Emigrant of Thought', in Poague, Conversations, p. 151; J. Cott, a
y
'Susan Sontag: The Rolling Stone Interview', in Poague, Conversations, p. 108. 2
1
9 Sontag, Illness as Metaphor, pp. 5, 58, 61, 72-3, 101-2 and D. H. Lawrence quoted in Sontag, , 2
Illness as Metaphor, p. 84. In Reconstructing Illness, Hawkins provides a fascinating analysis of metaphor01s
used by cancer sufferers in post-war America. She points out that 'book-length personal accounts of 3
illness are uncommon before 1950 and rarely found before 1900' (p. 3). Moreover, she notes that
'pathographies' written in the late 1970s and 1980s, after the publication of Sontag's book, were
markedly different in 'tone and intent' (p. 5). Those written after the war tended to celebrate the pos-
sibilities of modern medicine for cure and relief while those written later were more often critical or
distrustful of the medical establishment. On the one hand, Sontag's work occupies an unusual place in
this genre because it does not resemble other pathographies of the period. On the other hand, it
exhibits important affinities with early illness narratives because Sontag lauds the power of medicine,
not only over illness, but also over metaphor. For further discussion of Sontag's interpretation of
cancer metaphors, see Hawkins, Reconstructing Illness, pp. 22—4; Lupton, Medicine as Culture, pp. 57—8,
66-9; J. Stacey, Teratologies: A Cultural Study of Cancer (London, 1997), pp. 44-8,62-4.
Who's Afraid of Susan Sontag? 297
because they rendered the illness disgraceful. As Sontag argued, 'conventions of
treating cancer as no mere disease but a demonic enemy make [it] not just a lethal
disease but a shameful one'. At the same time, metaphoric meanings had very
serious practical consequences in the lives of patients because they tended to
interfere with proper treatment. Sontag observed that 'having cancer has been
experienced by many as shameful, [and] therefore something to conceal'. If suffer-
ers were reluctant to acknowledge their symptoms or their illnesses, they were less
likely to seek competent care, with the result that their cancers were frequendy D
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untreatable by the time they consulted a physician. Sontag consequently con- w
n
cluded that, 'metaphors and myths. . . kill'.ln loa
d
Her solution to the problems posed by disease metaphors was simply to elimin- ed
ate them from the discourse on cancer. She believed that, once the disease had been fro
m
stripped of symbolic associations, sufferers would realize cancer was a biological h
phenomenon rather than a social or moral one. Patients would then be free to ttp://s
pursue the most effective treatments available from the most competent medical h
m
practitioners. 'My point', Sontag wrote, 'is that illness is not a metaphor, and that .o
x
the most truthful way of regarding illness—and the healthiest way of being ill—is ford
one most purified of, most resistant to, metaphoric thinking'. Ultimately, Sontag jou
assumed that cancer metaphors would wither away naturally once medical science rna
ls
uncovered the causes of the disease and devised a cure. Tuberculosis sufferers, she .o
rg
argued, had already been liberated from the evils of metaphor by the discovery of a/
antibiotics. Until a cure for cancer was forthcoming, however, metaphors had to t N
a
be stripped of their power by being 'exposed, criticized, belabored, used up'. tio
n
a
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A Conspiracy of Silence? ng
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According to Sontag, the social 'conventions of concealment' associated with n
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cancer eased considerably in the decades after the end of the Second World War U
n
when the rising tide of malpractice suits and altered sensibilities encouraged ive
rs
doctors and patients alike to approach the problem of cancer with greater candour. ity
Implicit in her account was the assumption that, prior to the 1940s and 1950s, Lib
neoplastic diseases had aroused the deepest disgust and bred the deepest silence. ra
ry
Doctors hesitated to mention cancer because they believed it would intensify the o
n
suffering and hasten the deaths of their patients. In turn, sufferers who knew they M
a
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had cancer allegedly tried to hide it, fearing for their jobs or their relationships. 2
1
James Patterson concluded that 'most of those who developed cancer before the , 2
0
1940s were either not told they had it or tried to keep the news out of the papers'. 13
Cancer was the unmentionable affliction and its victims untouchable.12 In fact,
neither private nor public discourse entirely supports these assumptions about
North American reactions to cancer. Although many people shrank from a frank
discussion of the disease as well as knowledge of a devastating diagnosis, their
10 Sontag, Illness as Metaphor, pp. 6—7, 57, 101—2, 112. See also Lupton, Medicine as Culture, p. 58.
" Sontag, Illness as Metaphor, pp. 3 (original emphasis), 102, 182.
12 Sontag, Illness as Metaphor, pp. 7—8, 103—4; Patterson, Dread Disease, pp. 30, 69, 151 (emphasis
added).
298 Barbara Clow
reticence was not absolute, as implied by the term 'silence'. In a variety of ways and
for a number of reasons, doctors, sufferers, and the general public were frequently
prepared to read, write, and talk about cancer.13
Consider, for example, obituaries and death notices, which supposedly provided
the strongest evidence of cultural taboos against cancer. According to Patterson, as
late as 1949 'obituaries for thousands of people [who died of cancer] . . . still used
familiar euphemisms to avoid the stigma of the disease'. Phrases such as 'a lingering
illness' or 'a prolonged illness', he claimed, routinely signified cancer deaths. D
o
Although this interpretation of cancer may seem both familiar and persuasive, it is w
n
fraught with problems. Even if we concede a direct correlation between the use of loa
d
the phrase 'a lingering illness' and cancer deaths, we cannot therefore conclude ed
that relatives were intent on concealing the disease by neglecting to name it. fro
m
Euphemisms are employed precisely because they facilitate discussion of delicate, h
private, or difficult subjects, such as sex or death. Consequently, if euphemisms ttp://s
were used habitually, as Patterson and Sontag insisted, families who chose to h
m
describe a relative's demise in this fashion would actually be announcing rather .o
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than hiding the cause of death. As sociologist Jackie Stacey observed, 'As the ford
subject is avoided, it enters everyone's mind.'14 jou
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At the same time, there is currently little support for the assumption that every a
ls
'lingering illness' referred to in obituaries was cancer. Many afflictions, including .o
rg
cardiovascular diseases and diabetes, claimed lives slowly, over the course of many a/
years, and these illnesses might well have been described as 'lingering' or 'pro- t N
a
tracted'. For example, Isabella Wallace's death came 'after many years of suffering tio
n
a
borne patiently', while Albert E. Bavidge passed away 'after a gallant fight for life'. l C
Were these prolonged, painful deaths due to cancer or to some other affliction? he
n
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Moreover, cancer deaths did not always follow an extended period of suffering. In K
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1910, a Toronto man suffering from leukemia died 'suddenly', following an opera- n
g
tion. When famed Canadian humourist Stephen Leacock succumbed to throat U
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cancer in 1944, his obituary characterized the cause of his death as 'an illness of ive
rs
several weeks'. The fact is we simply do not know which phrases, if any, served as ity
euphemisms for cancer. An example drawn from the pages of a Toronto news- L
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paper reveals the decided ambiguity of obituary evidence. On 8 August 1930, the ra
ry
death of H. Otto Scott was attributed to 'a lingering illness'. A veteran of the First o
n
World War, Scott had been gassed and 'had not recovered from the effects of the M
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war', being forced by ill-health to give up his work as a bookkeeper two years y 2
1
before his death. From our perspective, this obituary is strongly suggestive of , 2
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cancer. Not only did Scott's parents use the phrase 'a lingering illness', but also the 1
3
reference to mustard-gas exposure conjures up images of lung damage and possibly
pulmonary neoplasm. Yet such a conclusion would be premature. Several studies
of war veterans in the United States demonstrate only a marginal increase of lung
cancer among the victims of mustard-gas poisoning. Although a 'single combat
13 For further discussion of cancer experiences in the early twentieth century, see my forthcoming
book, Negotiating Disease: Power and Cancer Care, 1900-1950 (Montreal and Kingston, in press).
14 Sontag, Illness as Metaphor, p. 103; Patterson, Dread Disease, pp. 30, 151, 157; Stacey, Teratologies,
p. 64.
Who's Afraid of Susan Sontag? 299
exposure' would invariably leave these men suffering from severe asthma or
chronic, debilitating bronchitis, it did not significantly increase their chances of
developing cancer later in life. Otto Scott may well have succumbed to lung
cancer, but he may also have gasped away his last moments of life in the grip
of some other pulmonary condition. In other words, the relationship between
euphemisms and causes of death was far less obvious and predictable than that
described by Sontag and Patterson.13
Before we leap to conclusions about reportage of cancer deaths, we must also D
o
compare them with announcements of other causes of death in the same period. A w
n
survey of one Toronto newspaper, for instance, revealed that fewer than 15 per loa
d
cent of obituaries specified any cause of death, and this figure was often inflated by ed
media coverage of accidental deaths, especially car wrecks and drownings, which fro
m
doubled as news (see Figure 1). Moreover, many commonly fatal conditions h
were under-represented in obituaries and death notices: diabetes, puerperal fever, ttp://s
poliomyelitis, and a multitude of other lethal ailments, were rarely mentioned. Even h
m
cardiovascular diseases (CVD), the number one killer in North America, received .o
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scant attention, appearing in fewer than 3 per cent of obituaries and death notices. ford
Although cancer deaths were seriously under-reported in obituaries, figuring in jo
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only a handful of announcements, reticence about the disease must be understood rna
ls
in the context of a culture that valued privacy in matters of illness and dying. .o
rg
Indeed, the most common descriptor used in obituaries of the period was 'sud- a/
denly', suggesting that a public explanation was generally considered unnecessary t N
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or unwelcome except in the case of unexpected death. Firm conclusions about the tio
n
conventions governing death announcements must await a comprehensive review al C
of obituary evidence, yet even this preliminary analysis casts doubt on Sontag's and he
n
Patterson's conclusion that cancer deaths were uniquely subject to concealment or g K
disguise. Prior to the Second World War, relatives of the deceased apparently un
g
'tried to keep the news out of the papers' regardless of the cause of death. U
n
Although the tenor of obituaries and death notices was frequently restrained, the ive
rs
ity
15 Sontag, Illness as Metaphor, p. 103; Patterson, Dread Disease, pp. 151, 157; 'Died After Operation: L
Walter Plumstead Passed Away Suddenly at Hospital', Toronto Mail and Empire (13 August 1910); ibra
Death Notice, Isabella Deans Wallace, Toronto Mail and Empire (20 August 1925); Death Notice, Albert ry
E. Bavidge, Toronto Mail and Empire (20 January 1920); 'Mrs. Leacock Died in Liverpool Home', on
Montreal Gazette (15 December 1925); Death Notice, H. Otto Scott, Toronto Mail and Empire (8 M
August 1930); 'Stephen Leacock, 74, Succumbs: Noted Humorist and Economist', Montreal Gazette ay
(29 March 1944); G. W. Beebe, 'Lung Cancer in World War I Veterans: Possible Relation to 21
Mustard-Gas Injury and 1918 Influenza Epidemic', National Cancer Institute Journal, 25 (1960), 1231- , 2
0
51; J. E. Norman, Jr., 'Lung Cancer Mortality in World War I Veterans With Mustard-Gas Injury: 1
3
1918-1965', Journal of the National Cancer Institute, 54 (February 1975), 311-17. Although Patterson
maintains that relatives of those who died at Memorial Cancer Hospital, one of the oldest and most
prestigious cancer treatment centres in the United States, relied on euphemisms, his footnotes do not
provide evidence to support this conclusion.
16 In order to evaluate reportage of deaths, I surveyed two months of the Toronto Mail and Empire
(which became the Toronto Globe and Mail in 1936) at five-year intervals between 1900 and 1945. I
examined the January and August papers for these years in an effort to cover a wide variety of terminal
illnesses, including contagious diseases, such as pneumonia, which took their greatest toll in the winter
months, and accidental deaths, such as drownings, which frequently occurred during summer vaca-
tions. For obvious reasons, casualty lists published during the war years were not included in my
enumeration or analysis of obituaries.
300 Barbara Clow
1400
1200
1000
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1915 1920 1925 1930 1935 1940 1945 a
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FIG. 1. Survey of death notices and obituaries, 1900-50. Cardiovascular diseases (CVD), the number rg
one cause of death, were seldom mentioned in newspapers. at N/
Source: see note 16. atio
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same cannot be said of the wider public discourse on cancer. In the early decades of l C
the twentieth century, a variety of volunteer and public-health agencies in Canada he
n
and the United States began to disseminate information about neoplastic diseases in g K
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order to educate the public and the medical profession about symptoms, diagnosis, n
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and treatment. Patterson argued that much of this literature was aimed at counter- U
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ing the fear and shame that silenced cancer sufferers. Yet more to the point is the ive
fact that educational efforts such as these would have been pointless had not the rsity
public been willing to read about a distressing and ostensibly distasteful subject, L
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cancer. In the same way, editors of newspapers and popular magazines increasingly ra
ry
assumed that stories on the 'dread disease' would find an avid audience. A survey of o
n
articles indexed in The Readers' Guide to Periodical Literature reveals that media M
a
coverage of cancer frequently outstripped the attention devoted to other ailments, y 2
1
such as heart disease, which were ostensibly easier to discuss (see Figure 2). James , 2
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Patterson interpreted this imbalance of reportage as evidence that Americans were 1
3
in the grip of'cancerphobia', an irrational, unreasonable fear of the disease. What-
ever else the public discourse on cancer may have signified, it surely did not add up
to the 'conspiracy of silence' described by Sontag and Patterson.17
Prior to the Second World War, neoplastic diseases were allegedly excluded
from private as well as public discourse. 'Since getting cancer can be a scandal that
jeopardizes one's love life, one's chance of promotion, even one's job', Sontag
17 Patterson, Dread Disease, pp. 69, 82—4, 97; Sontag, Illness as Metaphor, pp. 7, 103; Sontag quoted
in Kahn, 'Alone', p. 52.
Wlic's Afraid of Susan Sontag? 301
D
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Fie;. 2. Total numberof articles appearing in The Readers' Guide to Periodical Literature, 1900-50. rg
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argued, 'patients who know what they have tend to be extremely prudish, if not tio
n
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outright secretive, about their disease.' Although the laity was desperately afraid of l C
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cancer, it is less clear that sufferers and their families felt constrained to hide the e
n
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disease. Large numbers of cancer patients contacted public and private agencies, K
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as well as medical specialists and alternative healers, for advice and assistance. n
g
Between 1935 and 1938, for example, the American Society for the Control of U
n
Cancer received close to 50,000 letters from sufferers and their families. Officials ive
rs
at the Ontario Department of Health likewise corresponded with hundreds of ity
patients in these years, advising them about suspicious symptoms and suitable Lib
therapy. Admittedly, these people represented only a tiny fraction of North Amer- rary
icans confronting neoplastic diseases, either in their own bodies or in the lives of o
n
their loved ones. If these letters constituted the only evidence of private discourse M
a
y
about cancer, we might well agree with Sontag's thesis, concluding that an out- 2
1
spoken minority does not disprove the general rule of silence. But lay testimony , 2
0
from this period also indicates that cancer patients regularly consulted friends, 13
family, and even neighbours about their illness and treatment. For example,
sufferers frequently remarked that their own decisions about cancer care were
informed by the experiences of others within their social circles. A woman with
carcinoma of the cervix refused radiation therapy after listening to the stories of
her neighbours. 'Three of my friends', she wrote, 'had similar treatment and they
told me they were dying a death of [a] fiery internal furnace. Knowing of their
untimely deaths and awful agony, I was determined to die comfortably, if needs be
by the inroads of cancerous growths.' Similarly, a man with bladder cancer refused
302 Barbara Clow
surgery at the Mayo Clinic because 'he noticed that most of those who went away
to be treated did not come back'. Comments such as these speak to the vitality and
importance of lay networks of communication in understanding the experience of
neoplastic diseases. Moreover, in combination with official correspondence, they
suggest that sufferers were not necessarily bound by social conventions of silence;
faced with a serious, potentially life-threatening disease, many shared their experi-
ences—and knowledge of their illness—with friends and relatives as well as with
health-care providers and government officials.18 D
o
w
Even in the doctor-patient relationship, secrecy was neither an uncontested nor n
lo
an uncomplicated phenomenon. To be sure, many physicians preferred to dis- a
d
e
semble about cancer, while the victims of the disease shunned a diagnosis that they d
felt was equivalent to a death sentence. According to a 1934 survey of cancer from
sufferers in Saskatchewan, six per cent had delayed consulting a doctor precisely h
ttp
because they feared they had cancer. Yet for every example of concealment, there ://s
was a comparable case in which patients and practitioners favoured candour over hm
silence or deception. As one sufferer wrote about his experience: 'The doctors .ox
were not a bit backward about telling me it was Cancer.'19 Moreover, reticence in ford
the medical encounter, like euphemisms in obituaries, served more complex pur- jou
rn
poses than simple evasion of the truth. Consider a situation described by a doctor a
ls
practising in rural Ontario. His patient, a man with rectal cancer, had refused a .org
colostomy and was dying. Rather than contemplate this dismal prognosis at regular a/
intervals, the patient and his physician 'evolved a little game' to avoid mentioning t N
a
the disease. At each visit, the man would ask if he was well and the doctor would tio
n
a
assure him that he was on the mend. Meanwhile, the patient was fully aware of his l C
h
impending death and its cause; he wrote up his will, set his business affairs in order, e
n
g
and bid farewell to his closest friend. Actor Humphrey Bogart adopted similar K
u
tactics when he was dying from oesophageal cancer. According to his widow, n
g
Lauren Bacall, Bogart never deceived himself about the nature of his affliction, U
n
insisting that cancer was a 'respectable' disease. None the less, the two of them, as ive
rs
Bacall wrote, 'continued the game of its being nothing more than a bad virus'. ity
Thus, when patients, their families, and their doctors enacted bedside rituals, they Lib
were not always intent on concealing the nature of the disease; instead, they were rary
seeking ways to manage a terrifying situation. o
n
M
a
y
18 Sontag, Illness as Metaphor, p. 8; 'Please Send Me—', Bulletin of the American Society for the Control o 21f
Cancer (hereafter ASCC Bulletin), 20 (November 1938), 8-10; 'Case History ofT.D.', Case Book 6, , 2
0
pp. 4-5, R. C. Wallace Papers, Series 1024b, Additions, Box 1, FilelO, Queen's University Archives, 13
Kingston, Ontario; R. J. Mannion, Life is an Adventure (Toronto, 1936), p. 88. See also H. R., 'Letter
to the Editor;' The Bracebridge Gazelle (11 June 1936); 'Case History of W. C.\ Case Book 3, p. 11, R.
C. Wallace Papers, Series 1024b, Additions, Box 1, File 9, Queen's University Archives, Kingston,
Ont.
19 E. E. Shepley, 'Why Late Diagnosis in Malignancy', Canadian Medical Association Journal (here-
after CMAJ), 31 (October 1934), 406-8; F.N.G. Starr, 'The Cancer Problem', CMAJ 30 (January
1934), p. 48; 'Shall We Tell the Cancer Patient the Truth?', ASCC Bulletin 17 (August 1935), 9-11;
C. B. Pierce, 'The Management of the Cancerous Patient Under Radiation Therapy', CMAJ, 47
(August 1942), 119-20; 'Letter to the Editor', The Bracebridge Gazette, (11 June 1936).
20 W. V.Johnston, Before the Age of Miracles: Memoirs of a Country Doctor (Toronto, 1972), pp. 168-9;
L. Bacall, By Myself (New York, 1979), pp. 243, 251.